Clinical Reasoning Case #4 Flashcards
My DDx is developed mostly from my exam that I gather from the patient and then supplemented by the history
(T/F)
False
Your history will aid in about ____% of your DDX and then your physical exam will supplement that information to develop a working diagnosis
80%
___% of the US population currently has, or has already had 1 or more episodes of back pain in the past 3 months
39%; Chronic LBP is common
LMNOPQRST PAA PAA is used for:
History of Present Illness
NMSVv is used for:
Differential Diagnosis
HIPPIRONILS is used for:
Clinical Flow
Scheurmann Disease
-A type of osteochondrosis
-Juvenile Kyphosis AKA
-Irritation of a growth center causing inflammation, which causes proliferation, poorly developed cartilage, fragmentation/irregularity
-Typically a genetic component
-Occurs w/ ADOLESCENTS (To be acute)! Have to be skeletally immature
-Not active in older adults
Where does Scheurmann’s Disease occur
-Thoracic spine mostly, but can be lumbar
-Presents as a rigid painful thoracic kyphosis
Contributing factors of Scheurmanns Disease
Mechanical stress
-Seen in athletes
-Young manual labourers
Osgood-Schlatter Disease
-Male Dominance
-11-15 years old
-History of single traumatic injury or repetitve stress
-Partial disruption at tibial tuberosity
-Pain, swelling, tenderness
Scheurmann Disease findings
Anterior vertebral body wedging
-Irregular endplates
-Decreased IVD heights
-Postural abnormalities
-Acute in skeletal..
Additional findings of Scheurmanns
-Thoracic spine kyphosis >40*
Atleast 3 adjacent vertebrae demonstrating >5*
-Schmorls nodes
-Irregular endplates
Five Things Physicians and Patients Should Question
- Do not obtain spinal imaging for patients w/ acute LBP during the 6 weeks after onset in the absence of red flags
- Do not perform repeat imaging to monitor patient’s progress
- Avoid protracted use of passive or palliative physical therapeutic modalities for LBP disorders unless they support the goals of an active treatment plan
- Do not provide long-term pain management w/o a psychosocial screening or assessment
- Do not prescribe lumbar supports or braces for the long-term treatment or prevention of LBP
Biological Components in the BPS model
-Age, gender, genetics
-Physiologic Reactions
-Tissue Health
Psychological Components of the BPS model
-Mental Health
-Emotional Health
-Beliefs and Expectations
Sociological Components of the BPS Model
-Interpersonal Relationships
-Social Support Dynamics
-Socioeconomics
What does the “Triad of Health” Include
Nutritional/Chemical, Structural/Physical, Emotional/Mental
Point prevalence of chronic pain among adults has been measured at up to ___% of the population in both developed and developing countries
41%
In the United States chronic pain is estimated to affect more than _______ adults, producing over _______dollars of direct and indirect costs each year
100 million; $600 billion
What accounts for the greatest cause of disability in both men and women in most countries worldwide?
Low back and neck pain
What is the dominant model to explain and manage pain
BPS model
Psychosocial factors shown to negatively contribute to heightened pain, awareness and disability
Fear-avoidance beliefs, depression and anxiety, PTSDs, unsupportive social and interpersonal relationships, low levels of self efficacy and maladaptive beliefs
The ________ Model is an example of the interconnectedness between biological and psychosocial influences that may contribute to persistent pain
Fear-Avoidance
In the Field study, Most patients that presented to an initial chiropractic visit with _____scores of psychological distress showed a _____ in these scores after a few days post visit
Higher; decrease
Psychosocial interventions used to develop resilience toward chronic pain
-CBT: Positive thinking, pain distracting activities, active relaxation exercises and stretching
-ACT: Mindfulness meditation, educational interventions such as “Explaining Pain” sessions
American College of Physicians non-pharmalogic guidelines
Mindful-based stressed reduction, progressive relaxation, CBT, exercise, yoga, tai chi, spinal manipulation and rehabilitation
Evans ABCS pneumonic
-A: Assess overall health
-B: Benefits of positive behaviour change for patient
-C: Routine chiropractic visits
-S: Stay the Course
When asked if they had tried to make changes in behavior at the advice of their chiropractor or osteopath, they reported an attempt to make changes in their health care behavior greater than ___of the time
85%
The ________ Model suggests that not only must self-efficacy be enhanced for successful behavior change, but the perceived benefits of changing a behavior must outweigh any negatives or barriers
Health Belief Model
Motivational Interviewing (MI)
-Helps identifying behavioural change, motivation and obstacles in patient-centered discussion
-Specifically designed for primary care setting where time is limited
Principles of MI
- Expressing empathy for the patient/health issue
- Developing discrepancy between what needs to occur and what the patient is expressing/willing to do
- “Rolling w/ resistance”-when patient expresses negativity to making changes
- Supporting self-efficacy: Doctor is ready to help when the patient is willing to make changes
CBT (Cognitive Behavioural Therapy)
-Structured approach that concentrates on the relationships between thoughts, emotions and behaviours
-Nurtures patient development and uses active problem solving skills in order to manage challenges with chronic pain
ACT
-Aims to focus on processes of language that are though to be involved in psychopathology and it’s amelioration
-Includes the viewpoint that attempting to change problematic thoughts and feelings as a means of coping can be disparaging
